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Raymond Levy - One of the best experts on this subject based on the ideXlab platform.
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Insight and paranoid disorders in late life (late paraphenia)
International Journal of Geriatric Psychiatry, 1996Co-Authors: Osvaldo P Almeida, Robert Howard, Raymond Levy, Anthony S DavidAbstract:Forty elderly patients with late Paraphrenia completed a standardized assessment of insight into psychosis along with a detailed cognitive and psychometric evaluation. Overall, the group had poorer insight than a comparable group of early onset schizophrenic patients. Insight was correlated with positive symptoms but appeared unrelated to negative symptoms, performance on neuropsychological tests including those of executive function, plus illness course and duration.
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psychotic states arising in late life late Paraphrenia psychopathology and nosology
British Journal of Psychiatry, 1995Co-Authors: Osvaldo P Almeida, Robert Howard, Raymond Levy, Anthony S DavidAbstract:BACKGROUND This study explored the psychopathological state of a sample of 'late paraphrenic' patients and the reliability of their diagnosis according to the most widely used systems of classification of mental disorders. METHOD The presence and severity of psychiatric symptoms were assessed with the Present State Examination (PSE), the Scale for the Assessment of Positive Symptoms (SAPS), and the High Royds Evaluation of Negativity (HEN) scale. Patient signs and symptoms were classified according to the PSE9-CATEGO4, DSM-III-R, DSM-IV, and ICD-10 diagnostic systems. Agreement among the 11 most widely used criteria for the diagnosis of schizophrenia was assessed for these patients. These included DSM-III-R, DSM-IV, ICD-10, Schneider, Langfeldt, New Haven Schizophrenia Index, Carpenter, Research Diagnostic Criteria (RDC), Feighner, Taylor & Abrams, and PSE9-CATEGO4. The study assessed 47 patients, including in-patients, out-patients, day-patients, and those in the community. Thirty-three elderly controls were recruited from luncheon clubs in Southwark and Lambeth (London, UK). RESULTS Patients showed a wide range of delusional ideas, most frequently involving persecution (83.0%) and reference (31.9%). Eighty-three per cent of patients reported some sort of hallucination, most frequently auditory (78.7%). Formal thought disorder was very rare, only one patient showing mild signs of circumstantial speech. No patients exhibited catatonic symptoms or inappropriate affect. Shallow, withdrawn, or constricted affect was found in only 8.5% of patients. The various systems of classification indicated that most patients displayed typical schizophrenic symptoms, although up to one-third of them did not meet criteria for the diagnosis of schizophrenia. There was poor agreement among the different diagnostic schedules as to whether to classify patients as schizophrenic (0.02 < k < 0.45). CONCLUSION Psychotic states arising in late life are accompanied by various psychiatric symptoms that are not entirely typical of early-onset schizophrenia. The current trend to include 'late Paraphrenia' into the diagnosis of schizophrenia or delusional disorder has poor empirical and theoretical bases.
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psychotic states arising in late life late Paraphrenia the role of risk factors
British Journal of Psychiatry, 1995Co-Authors: Osvaldo P Almeida, Robert Howard, Raymond Levy, Anthony S DavidAbstract:BACKGROUND This study explored the association between 'late Paraphrenia' and various risk factors such as female gender, sensory impairment, marital status, positive family history of psychoses, and the presence of abnormal neurological signs. It was hypothesised that patients would show significantly more abnormal neurological signs than controls. METHOD Inclusion criteria for the diagnosis of late Paraphrenia were fulfilled by 47 patients, including in-patients, out-patients, day-patients, and those living in the community. Thirty-three age-, sex-, education-, and premorbid IQ-matched elderly controls were recruited from luncheon clubs in Southwark and Lambeth (London, UK). A scale for the assessment of neurological soft and hard signs was developed for this study. The Abnormal Involuntary Movement Scale (AIMS) and the Tardive Dyskinesia Rating Scale (TDRS) were also used. RESULTS There was a high female-to-male ratio (42:5), and a fourfold increase in the risk of patients having hearing impairment (odds ratio = 4.15, Clodds = 1.36 to 12.63). There was no difference between the two groups in visual difficulties nor in marital status. Patients were approximately ten times more likely to be living on their own (odds ratio = 10.61; Clodds = 3.59 to 31.33) and 16 times more likely to be considered socially isolated (odds ratio = 16.65; Clodds = 5.39 to 51.40). There was no difference between patients and controls in frequency of schizophrenia-like family history. Patients were more likely than controls to exhibit neurological soft signs (z = 4.70; P < 0.001; Cld = 4.61 to 9.63). The presence of abnormal involuntary and tardive dyskinesia movements was associated with the use of antipsychotic medication. CONCLUSION Women appear to run a greater risk of developing late Paraphrenia, especially those who are socially isolated and present with associated hearing impairment. The increased presence of neurological soft signs among patients indicates that brain disease may be a critical factor in the development of psychotic symptoms in late life.
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apolipoprotein e genotype and late Paraphrenia
International Journal of Geriatric Psychiatry, 1995Co-Authors: Robert Howard, David Castle, John Dennehey, Simon Lovestone, Joseph Birkett, Pak C Sham, John Powell, Robin M Murray, Raymond LevyAbstract:Patients with late Paraphrenia or late onset schizophrenia frequently have associated cognitive impairment which may in some cases progress to a recognized dementia. The frequency of the apoE ϵ4 allele is high in individuals who develop Alzheimer's disease. Twenty‐three patients with late Paraphrenia were genotyped for ApoE. The frequency of the ϵ4 allele was comparable with that found in a large group of centenarians, but lower than previously reported from populations of normal controls and Alzheimer's disease patients. Two out of three male patients tested had the rare ϵ2/ϵ2 genotype, which was not found in any of the females. Copyright © 1995 John Wiley & Sons, Ltd.
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Quantitative magnetic resonance imaging volumetry distinguishes delusional disorder from late-onset schizophrenia
British Journal of Psychiatry, 1994Co-Authors: Robert Howard, Osvaldo P Almeida, Raymond Levy, Phillipa Graves, Martin J. GravesAbstract:BACKGROUND Late Paraphrenia is recognised as a heterogeneous disorder. This is reflected by the division of such patients into schizophrenia and delusional disorder in ICD-10. Earlier imaging studies have suggested that major structural abnormalities may be associated with the onset of psychosis in later life. METHOD Fifty late paraphrenics and 35 age-matched healthy controls underwent structural magnetic resonance imaging of the whole brain in the coronal plane. Measurements were made of intracranial and brain volumes and the volumes of the intracerebral and extracerebral cerebrospinal fluid spaces. RESULTS No differences in intracranial, brain or extracerebral cerebrospinal fluid volumes between patients and controls were found. Late paraphrenic patients had greater lateral and third ventricle volumes than controls and the left lateral ventricle was larger than the right. When the patients were divided into appropriate ICD-10 diagnoses: paranoid schizophrenia (n = 31) and delusional disorder (n = 16), lateral ventricle volumes in the delusional disorder patients were much greater than those of the schizophrenics and almost twice those of controls. CONCLUSIONS Structural brain differences underly diagnostic heterogeneity within late Paraphrenia. The brains of late onset schizophrenics are only subtly different from those of healthy elderly individuals.
Robert Howard - One of the best experts on this subject based on the ideXlab platform.
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Insight and paranoid disorders in late life (late paraphenia)
International Journal of Geriatric Psychiatry, 1996Co-Authors: Osvaldo P Almeida, Robert Howard, Raymond Levy, Anthony S DavidAbstract:Forty elderly patients with late Paraphrenia completed a standardized assessment of insight into psychosis along with a detailed cognitive and psychometric evaluation. Overall, the group had poorer insight than a comparable group of early onset schizophrenic patients. Insight was correlated with positive symptoms but appeared unrelated to negative symptoms, performance on neuropsychological tests including those of executive function, plus illness course and duration.
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psychotic states arising in late life late Paraphrenia psychopathology and nosology
British Journal of Psychiatry, 1995Co-Authors: Osvaldo P Almeida, Robert Howard, Raymond Levy, Anthony S DavidAbstract:BACKGROUND This study explored the psychopathological state of a sample of 'late paraphrenic' patients and the reliability of their diagnosis according to the most widely used systems of classification of mental disorders. METHOD The presence and severity of psychiatric symptoms were assessed with the Present State Examination (PSE), the Scale for the Assessment of Positive Symptoms (SAPS), and the High Royds Evaluation of Negativity (HEN) scale. Patient signs and symptoms were classified according to the PSE9-CATEGO4, DSM-III-R, DSM-IV, and ICD-10 diagnostic systems. Agreement among the 11 most widely used criteria for the diagnosis of schizophrenia was assessed for these patients. These included DSM-III-R, DSM-IV, ICD-10, Schneider, Langfeldt, New Haven Schizophrenia Index, Carpenter, Research Diagnostic Criteria (RDC), Feighner, Taylor & Abrams, and PSE9-CATEGO4. The study assessed 47 patients, including in-patients, out-patients, day-patients, and those in the community. Thirty-three elderly controls were recruited from luncheon clubs in Southwark and Lambeth (London, UK). RESULTS Patients showed a wide range of delusional ideas, most frequently involving persecution (83.0%) and reference (31.9%). Eighty-three per cent of patients reported some sort of hallucination, most frequently auditory (78.7%). Formal thought disorder was very rare, only one patient showing mild signs of circumstantial speech. No patients exhibited catatonic symptoms or inappropriate affect. Shallow, withdrawn, or constricted affect was found in only 8.5% of patients. The various systems of classification indicated that most patients displayed typical schizophrenic symptoms, although up to one-third of them did not meet criteria for the diagnosis of schizophrenia. There was poor agreement among the different diagnostic schedules as to whether to classify patients as schizophrenic (0.02 < k < 0.45). CONCLUSION Psychotic states arising in late life are accompanied by various psychiatric symptoms that are not entirely typical of early-onset schizophrenia. The current trend to include 'late Paraphrenia' into the diagnosis of schizophrenia or delusional disorder has poor empirical and theoretical bases.
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psychotic states arising in late life late Paraphrenia the role of risk factors
British Journal of Psychiatry, 1995Co-Authors: Osvaldo P Almeida, Robert Howard, Raymond Levy, Anthony S DavidAbstract:BACKGROUND This study explored the association between 'late Paraphrenia' and various risk factors such as female gender, sensory impairment, marital status, positive family history of psychoses, and the presence of abnormal neurological signs. It was hypothesised that patients would show significantly more abnormal neurological signs than controls. METHOD Inclusion criteria for the diagnosis of late Paraphrenia were fulfilled by 47 patients, including in-patients, out-patients, day-patients, and those living in the community. Thirty-three age-, sex-, education-, and premorbid IQ-matched elderly controls were recruited from luncheon clubs in Southwark and Lambeth (London, UK). A scale for the assessment of neurological soft and hard signs was developed for this study. The Abnormal Involuntary Movement Scale (AIMS) and the Tardive Dyskinesia Rating Scale (TDRS) were also used. RESULTS There was a high female-to-male ratio (42:5), and a fourfold increase in the risk of patients having hearing impairment (odds ratio = 4.15, Clodds = 1.36 to 12.63). There was no difference between the two groups in visual difficulties nor in marital status. Patients were approximately ten times more likely to be living on their own (odds ratio = 10.61; Clodds = 3.59 to 31.33) and 16 times more likely to be considered socially isolated (odds ratio = 16.65; Clodds = 5.39 to 51.40). There was no difference between patients and controls in frequency of schizophrenia-like family history. Patients were more likely than controls to exhibit neurological soft signs (z = 4.70; P < 0.001; Cld = 4.61 to 9.63). The presence of abnormal involuntary and tardive dyskinesia movements was associated with the use of antipsychotic medication. CONCLUSION Women appear to run a greater risk of developing late Paraphrenia, especially those who are socially isolated and present with associated hearing impairment. The increased presence of neurological soft signs among patients indicates that brain disease may be a critical factor in the development of psychotic symptoms in late life.
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apolipoprotein e genotype and late Paraphrenia
International Journal of Geriatric Psychiatry, 1995Co-Authors: Robert Howard, David Castle, John Dennehey, Simon Lovestone, Joseph Birkett, Pak C Sham, John Powell, Robin M Murray, Raymond LevyAbstract:Patients with late Paraphrenia or late onset schizophrenia frequently have associated cognitive impairment which may in some cases progress to a recognized dementia. The frequency of the apoE ϵ4 allele is high in individuals who develop Alzheimer's disease. Twenty‐three patients with late Paraphrenia were genotyped for ApoE. The frequency of the ϵ4 allele was comparable with that found in a large group of centenarians, but lower than previously reported from populations of normal controls and Alzheimer's disease patients. Two out of three male patients tested had the rare ϵ2/ϵ2 genotype, which was not found in any of the females. Copyright © 1995 John Wiley & Sons, Ltd.
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Quantitative magnetic resonance imaging volumetry distinguishes delusional disorder from late-onset schizophrenia
British Journal of Psychiatry, 1994Co-Authors: Robert Howard, Osvaldo P Almeida, Raymond Levy, Phillipa Graves, Martin J. GravesAbstract:BACKGROUND Late Paraphrenia is recognised as a heterogeneous disorder. This is reflected by the division of such patients into schizophrenia and delusional disorder in ICD-10. Earlier imaging studies have suggested that major structural abnormalities may be associated with the onset of psychosis in later life. METHOD Fifty late paraphrenics and 35 age-matched healthy controls underwent structural magnetic resonance imaging of the whole brain in the coronal plane. Measurements were made of intracranial and brain volumes and the volumes of the intracerebral and extracerebral cerebrospinal fluid spaces. RESULTS No differences in intracranial, brain or extracerebral cerebrospinal fluid volumes between patients and controls were found. Late paraphrenic patients had greater lateral and third ventricle volumes than controls and the left lateral ventricle was larger than the right. When the patients were divided into appropriate ICD-10 diagnoses: paranoid schizophrenia (n = 31) and delusional disorder (n = 16), lateral ventricle volumes in the delusional disorder patients were much greater than those of the schizophrenics and almost twice those of controls. CONCLUSIONS Structural brain differences underly diagnostic heterogeneity within late Paraphrenia. The brains of late onset schizophrenics are only subtly different from those of healthy elderly individuals.
Osvaldo P Almeida - One of the best experts on this subject based on the ideXlab platform.
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Insight and paranoid disorders in late life (late paraphenia)
International Journal of Geriatric Psychiatry, 1996Co-Authors: Osvaldo P Almeida, Robert Howard, Raymond Levy, Anthony S DavidAbstract:Forty elderly patients with late Paraphrenia completed a standardized assessment of insight into psychosis along with a detailed cognitive and psychometric evaluation. Overall, the group had poorer insight than a comparable group of early onset schizophrenic patients. Insight was correlated with positive symptoms but appeared unrelated to negative symptoms, performance on neuropsychological tests including those of executive function, plus illness course and duration.
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cognitive features of psychotic states arising in late life late Paraphrenia
Psychological Medicine, 1995Co-Authors: Osvaldo P Almeida, R Levy, Anthony S David, R J Howard, Robin G Morris, Barbara J SahakianAbstract:The cognitive performance of 47 elderly psychotic patients with onset of symptoms in late life (late Paraphrenia) was compared to that of 33 controls matched for age, sex, ethnic origin, number of years of education, and pre-morbid IQ as measured by the NART. Neuropsychological indices of general cognitive functioning (MMSE, CAMCOG, WAIS-R verbal and performance scores) showed that patients were performing the tasks at a significantly lower level than controls. Patients also showed a trend to have a lower span capacity than controls, particularly at the spatial span subtest. There was no obvious impairment of learning as measured by the digit and spatial recurring span tasks nor of simultaneous matching-to-sample ability. However, patients' performance on a delayed-matching-to-sample procedure was significantly worse than that of controls. In addition, patients performed worse than controls on the Recognition Memory Test for Faces, but not for Words. Finally, the performance of patients on tests assessing executive functioning (Verbal Fluency Test, Computerized Extra and Intra-Dimensional Shift Task, Computerized Spatial Working Memory Task, and Computerized Tower of London Task) was consistently worse than that of controls. These results suggest that psychotic states arising in late life are predominantly associated with a decline on measures of general cognitive ability and executive functioning. The neuropsychological meaning of these findings is discussed in the light of cognitive models of psychotic symptoms, as well as of schizophrenia and dementia research. We concluded that the lack of a clear pattern of impairment among these patients may be the result of their clinical and cognitive diversity.
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psychotic states arising in late life late Paraphrenia psychopathology and nosology
British Journal of Psychiatry, 1995Co-Authors: Osvaldo P Almeida, Robert Howard, Raymond Levy, Anthony S DavidAbstract:BACKGROUND This study explored the psychopathological state of a sample of 'late paraphrenic' patients and the reliability of their diagnosis according to the most widely used systems of classification of mental disorders. METHOD The presence and severity of psychiatric symptoms were assessed with the Present State Examination (PSE), the Scale for the Assessment of Positive Symptoms (SAPS), and the High Royds Evaluation of Negativity (HEN) scale. Patient signs and symptoms were classified according to the PSE9-CATEGO4, DSM-III-R, DSM-IV, and ICD-10 diagnostic systems. Agreement among the 11 most widely used criteria for the diagnosis of schizophrenia was assessed for these patients. These included DSM-III-R, DSM-IV, ICD-10, Schneider, Langfeldt, New Haven Schizophrenia Index, Carpenter, Research Diagnostic Criteria (RDC), Feighner, Taylor & Abrams, and PSE9-CATEGO4. The study assessed 47 patients, including in-patients, out-patients, day-patients, and those in the community. Thirty-three elderly controls were recruited from luncheon clubs in Southwark and Lambeth (London, UK). RESULTS Patients showed a wide range of delusional ideas, most frequently involving persecution (83.0%) and reference (31.9%). Eighty-three per cent of patients reported some sort of hallucination, most frequently auditory (78.7%). Formal thought disorder was very rare, only one patient showing mild signs of circumstantial speech. No patients exhibited catatonic symptoms or inappropriate affect. Shallow, withdrawn, or constricted affect was found in only 8.5% of patients. The various systems of classification indicated that most patients displayed typical schizophrenic symptoms, although up to one-third of them did not meet criteria for the diagnosis of schizophrenia. There was poor agreement among the different diagnostic schedules as to whether to classify patients as schizophrenic (0.02 < k < 0.45). CONCLUSION Psychotic states arising in late life are accompanied by various psychiatric symptoms that are not entirely typical of early-onset schizophrenia. The current trend to include 'late Paraphrenia' into the diagnosis of schizophrenia or delusional disorder has poor empirical and theoretical bases.
-
psychotic states arising in late life late Paraphrenia the role of risk factors
British Journal of Psychiatry, 1995Co-Authors: Osvaldo P Almeida, Robert Howard, Raymond Levy, Anthony S DavidAbstract:BACKGROUND This study explored the association between 'late Paraphrenia' and various risk factors such as female gender, sensory impairment, marital status, positive family history of psychoses, and the presence of abnormal neurological signs. It was hypothesised that patients would show significantly more abnormal neurological signs than controls. METHOD Inclusion criteria for the diagnosis of late Paraphrenia were fulfilled by 47 patients, including in-patients, out-patients, day-patients, and those living in the community. Thirty-three age-, sex-, education-, and premorbid IQ-matched elderly controls were recruited from luncheon clubs in Southwark and Lambeth (London, UK). A scale for the assessment of neurological soft and hard signs was developed for this study. The Abnormal Involuntary Movement Scale (AIMS) and the Tardive Dyskinesia Rating Scale (TDRS) were also used. RESULTS There was a high female-to-male ratio (42:5), and a fourfold increase in the risk of patients having hearing impairment (odds ratio = 4.15, Clodds = 1.36 to 12.63). There was no difference between the two groups in visual difficulties nor in marital status. Patients were approximately ten times more likely to be living on their own (odds ratio = 10.61; Clodds = 3.59 to 31.33) and 16 times more likely to be considered socially isolated (odds ratio = 16.65; Clodds = 5.39 to 51.40). There was no difference between patients and controls in frequency of schizophrenia-like family history. Patients were more likely than controls to exhibit neurological soft signs (z = 4.70; P < 0.001; Cld = 4.61 to 9.63). The presence of abnormal involuntary and tardive dyskinesia movements was associated with the use of antipsychotic medication. CONCLUSION Women appear to run a greater risk of developing late Paraphrenia, especially those who are socially isolated and present with associated hearing impairment. The increased presence of neurological soft signs among patients indicates that brain disease may be a critical factor in the development of psychotic symptoms in late life.
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Quantitative magnetic resonance imaging volumetry distinguishes delusional disorder from late-onset schizophrenia
British Journal of Psychiatry, 1994Co-Authors: Robert Howard, Osvaldo P Almeida, Raymond Levy, Phillipa Graves, Martin J. GravesAbstract:BACKGROUND Late Paraphrenia is recognised as a heterogeneous disorder. This is reflected by the division of such patients into schizophrenia and delusional disorder in ICD-10. Earlier imaging studies have suggested that major structural abnormalities may be associated with the onset of psychosis in later life. METHOD Fifty late paraphrenics and 35 age-matched healthy controls underwent structural magnetic resonance imaging of the whole brain in the coronal plane. Measurements were made of intracranial and brain volumes and the volumes of the intracerebral and extracerebral cerebrospinal fluid spaces. RESULTS No differences in intracranial, brain or extracerebral cerebrospinal fluid volumes between patients and controls were found. Late paraphrenic patients had greater lateral and third ventricle volumes than controls and the left lateral ventricle was larger than the right. When the patients were divided into appropriate ICD-10 diagnoses: paranoid schizophrenia (n = 31) and delusional disorder (n = 16), lateral ventricle volumes in the delusional disorder patients were much greater than those of the schizophrenics and almost twice those of controls. CONCLUSIONS Structural brain differences underly diagnostic heterogeneity within late Paraphrenia. The brains of late onset schizophrenics are only subtly different from those of healthy elderly individuals.
Anthony S David - One of the best experts on this subject based on the ideXlab platform.
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Insight and paranoid disorders in late life (late paraphenia)
International Journal of Geriatric Psychiatry, 1996Co-Authors: Osvaldo P Almeida, Robert Howard, Raymond Levy, Anthony S DavidAbstract:Forty elderly patients with late Paraphrenia completed a standardized assessment of insight into psychosis along with a detailed cognitive and psychometric evaluation. Overall, the group had poorer insight than a comparable group of early onset schizophrenic patients. Insight was correlated with positive symptoms but appeared unrelated to negative symptoms, performance on neuropsychological tests including those of executive function, plus illness course and duration.
-
cognitive features of psychotic states arising in late life late Paraphrenia
Psychological Medicine, 1995Co-Authors: Osvaldo P Almeida, R Levy, Anthony S David, R J Howard, Robin G Morris, Barbara J SahakianAbstract:The cognitive performance of 47 elderly psychotic patients with onset of symptoms in late life (late Paraphrenia) was compared to that of 33 controls matched for age, sex, ethnic origin, number of years of education, and pre-morbid IQ as measured by the NART. Neuropsychological indices of general cognitive functioning (MMSE, CAMCOG, WAIS-R verbal and performance scores) showed that patients were performing the tasks at a significantly lower level than controls. Patients also showed a trend to have a lower span capacity than controls, particularly at the spatial span subtest. There was no obvious impairment of learning as measured by the digit and spatial recurring span tasks nor of simultaneous matching-to-sample ability. However, patients' performance on a delayed-matching-to-sample procedure was significantly worse than that of controls. In addition, patients performed worse than controls on the Recognition Memory Test for Faces, but not for Words. Finally, the performance of patients on tests assessing executive functioning (Verbal Fluency Test, Computerized Extra and Intra-Dimensional Shift Task, Computerized Spatial Working Memory Task, and Computerized Tower of London Task) was consistently worse than that of controls. These results suggest that psychotic states arising in late life are predominantly associated with a decline on measures of general cognitive ability and executive functioning. The neuropsychological meaning of these findings is discussed in the light of cognitive models of psychotic symptoms, as well as of schizophrenia and dementia research. We concluded that the lack of a clear pattern of impairment among these patients may be the result of their clinical and cognitive diversity.
-
psychotic states arising in late life late Paraphrenia psychopathology and nosology
British Journal of Psychiatry, 1995Co-Authors: Osvaldo P Almeida, Robert Howard, Raymond Levy, Anthony S DavidAbstract:BACKGROUND This study explored the psychopathological state of a sample of 'late paraphrenic' patients and the reliability of their diagnosis according to the most widely used systems of classification of mental disorders. METHOD The presence and severity of psychiatric symptoms were assessed with the Present State Examination (PSE), the Scale for the Assessment of Positive Symptoms (SAPS), and the High Royds Evaluation of Negativity (HEN) scale. Patient signs and symptoms were classified according to the PSE9-CATEGO4, DSM-III-R, DSM-IV, and ICD-10 diagnostic systems. Agreement among the 11 most widely used criteria for the diagnosis of schizophrenia was assessed for these patients. These included DSM-III-R, DSM-IV, ICD-10, Schneider, Langfeldt, New Haven Schizophrenia Index, Carpenter, Research Diagnostic Criteria (RDC), Feighner, Taylor & Abrams, and PSE9-CATEGO4. The study assessed 47 patients, including in-patients, out-patients, day-patients, and those in the community. Thirty-three elderly controls were recruited from luncheon clubs in Southwark and Lambeth (London, UK). RESULTS Patients showed a wide range of delusional ideas, most frequently involving persecution (83.0%) and reference (31.9%). Eighty-three per cent of patients reported some sort of hallucination, most frequently auditory (78.7%). Formal thought disorder was very rare, only one patient showing mild signs of circumstantial speech. No patients exhibited catatonic symptoms or inappropriate affect. Shallow, withdrawn, or constricted affect was found in only 8.5% of patients. The various systems of classification indicated that most patients displayed typical schizophrenic symptoms, although up to one-third of them did not meet criteria for the diagnosis of schizophrenia. There was poor agreement among the different diagnostic schedules as to whether to classify patients as schizophrenic (0.02 < k < 0.45). CONCLUSION Psychotic states arising in late life are accompanied by various psychiatric symptoms that are not entirely typical of early-onset schizophrenia. The current trend to include 'late Paraphrenia' into the diagnosis of schizophrenia or delusional disorder has poor empirical and theoretical bases.
-
psychotic states arising in late life late Paraphrenia the role of risk factors
British Journal of Psychiatry, 1995Co-Authors: Osvaldo P Almeida, Robert Howard, Raymond Levy, Anthony S DavidAbstract:BACKGROUND This study explored the association between 'late Paraphrenia' and various risk factors such as female gender, sensory impairment, marital status, positive family history of psychoses, and the presence of abnormal neurological signs. It was hypothesised that patients would show significantly more abnormal neurological signs than controls. METHOD Inclusion criteria for the diagnosis of late Paraphrenia were fulfilled by 47 patients, including in-patients, out-patients, day-patients, and those living in the community. Thirty-three age-, sex-, education-, and premorbid IQ-matched elderly controls were recruited from luncheon clubs in Southwark and Lambeth (London, UK). A scale for the assessment of neurological soft and hard signs was developed for this study. The Abnormal Involuntary Movement Scale (AIMS) and the Tardive Dyskinesia Rating Scale (TDRS) were also used. RESULTS There was a high female-to-male ratio (42:5), and a fourfold increase in the risk of patients having hearing impairment (odds ratio = 4.15, Clodds = 1.36 to 12.63). There was no difference between the two groups in visual difficulties nor in marital status. Patients were approximately ten times more likely to be living on their own (odds ratio = 10.61; Clodds = 3.59 to 31.33) and 16 times more likely to be considered socially isolated (odds ratio = 16.65; Clodds = 5.39 to 51.40). There was no difference between patients and controls in frequency of schizophrenia-like family history. Patients were more likely than controls to exhibit neurological soft signs (z = 4.70; P < 0.001; Cld = 4.61 to 9.63). The presence of abnormal involuntary and tardive dyskinesia movements was associated with the use of antipsychotic medication. CONCLUSION Women appear to run a greater risk of developing late Paraphrenia, especially those who are socially isolated and present with associated hearing impairment. The increased presence of neurological soft signs among patients indicates that brain disease may be a critical factor in the development of psychotic symptoms in late life.
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An experimental phenomenological approach to delusional memory in schizophrenia and late Paraphrenia.
Psychological Medicine, 1994Co-Authors: Anthony S David, Robert HowardAbstract:: A preliminary model is described to account for the 'reality testing' of memories (after Johnson & Raye, 1981) in an attempt to explain delusional memory. Two routes are proposed: route one involves evaluation of the factual content of the memories against stored general knowledge. Route two relies on the evaluation of the perceptual and narrative characteristics of memories with the assumption that the stronger these characteristics, the more likely the memory is to be real. The integrity of these routes is examined in four patients with delusional memories, using standardized tests. The results suggest that in these cases, general knowledge is essentially intact while the perceptual characteristics of delusional memories are stronger than real memories which in turn, are stronger than fantasies. This could lead the evaluation system to accept delusional memories as true memories despite their implausibility. The roles of rehearsal and affect are probably important in this and require further study.
Hans Forstl - One of the best experts on this subject based on the ideXlab platform.
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Neuropathological and neuroradiological correlates of paranoid symptoms in organic mental disease
European Archives of Psychiatry and Clinical Neuroscience, 1997Co-Authors: Alistair Burns, Hans ForstlAbstract:This paper reviews paranoid symptoms in older patients with organic mental disease. We have taken a dual approach to this topic, examining patients with dementia in whom paranoid symptoms are present and also assessing the presence of organic brain changes in patients diagnosed as having late-onset schizophrenia, Paraphrenia or delusional disorder. (For the sake of continuity and not wishing to pre-empt any discussion of the nosological categorisation of late-onset psychoses, we refer to late-onset persecutory state as Paraphrenia.) Firstly, there is a description of the various paranoid symptoms which have been described in patients with dementia. Secondly, brain imaging studies are discussed which have highlighted changes in patients with Paraphrenia and particular associations between psychotic phenomenology and brain changes in patients with dementia. Thirdly, neuropathological and neurochemical changes in the brains of patients with dementia in whom paranoid symptoms have been present are presented. We intersperse all three sections with data from work carried out by the authors at the Institute of Psychiatry in London from 1986 and 1992. For other reviews, see Allen and Burns (1995), Burns and Förstl(1996), Eisiri (1996) and Howard (1996).
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late onset schizophrenia and late Paraphrenia
Schizophrenia Bulletin, 1995Co-Authors: Anita Riecherrossler, Hans Forstl, Wulf Rossler, U MeiseAbstract:: The term "late-onset schizophrenia" was first coined by Manfred Bleuler (1943) to describe a form of schizophrenia with an onset between the ages of 40 and 60. This concept has been adopted by German psychiatry. Until recently, British and American psychiatrists had little interest in this patient group. However, they often used the term "late-onset schizophrenia" interchangeably with late Paraphrenia or as a generic term for both these diseases, even though the concept of late Paraphrenia is quite different from that of late-onset schizophrenia. Late Paraphrenia is a British concept that includes all delusional disorders starting after age 60. This confusion of terms and concepts is even more important now, because recent neuroimaging and neuropsychological studies suggest that an organic substrate probably exists in most cases of late Paraphrenia, while only minor organic abnormalities can be found in late-onset schizophrenia. We believe it is of utmost importance to establish a clear boundary between late-onset schizophrenia and other delusional disorders in middle and old age, because the confusion in terminology and concepts is a serious impediment to comparative international research.
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Computer‐assisted CT measurements in late paraphrenics with and without Schneiderian first‐rank symptoms: A preliminary report
International Journal of Geriatric Psychiatry, 1992Co-Authors: Robert Howard, Hans Forstl, Osvaldo P Almeida, Alistair Burns, Raymond LevyAbstract:Computer-assisted measurements were made on the computed tomography (CT) scans of 14 patients meeting ICD-9 diagnostic criteria for late Paraphrenia, seven of whom had exhibited one or more first-rank symptoms during their illness. When the CT scans of all 14 late paraphrenics were compared with those of an age-matched healthy control group, there were no significant differences with regard to planimetric measurements of brain and ventricle areas. Comparison of the scans of late paraphrenics with first-rank symptoms and those without them demonstrated that late paraphrenics without first-rank symptoms had a greater degree of cerebral atrophy, which was significantly so for the left frontal lobe. The findings support the observation that late Paraphrenia is a heterogeneous condition which is comprised of a group with first-rank symptoms who probably represent late-onset schizophrenia and a group without first-rank symptoms who have structural brain abnormalities and a presumed organic substrate for their symptoms that is impossible to exclude through clinical evaluation.
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first rank symptoms of schneider in late Paraphrenia cortical structural correlates
British Journal of Psychiatry, 1992Co-Authors: Robert Howard, Hans Forstl, Alistair Burns, Mohsen Naguib, Raymond LevyAbstract:The brains of 41 late paraphrenics, 16 of whom had first-rank symptoms, were examined by CT. Late paraphrenics with first-rank symptoms had significantly less cortical atrophy than those without them.
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Paraphrenia in the elderly psychopathologic and computer tomography indications of two subtypes
Nervenarzt, 1991Co-Authors: Hans Forstl, Robert Howard, Osvaldo P Almeida, Alistair Burns, Mohsen Naguib, R LevyAbstract:: Psychopathological and cranial computed tomography findings in 48 patients with late Paraphrenia were compared with the findings in 40 normal controls. 19 patients with late Paraphrenia and first rank symptoms showed significantly less cortical atrophy than 29 patients without first rank symptoms (p less than 0.01). There were no significant differences of ventricular enlargement, cerebellar atrophy, the presence of leukoaraiosis or basal ganglia mineralisation between the late paraphrenic and control groups. In contrast to the controls, cortical atrophy, ventricular enlargement and the presence of leukoaraiosis were not age-related. These results may indicate different origins of late Paraphrenia with or without first rank symptoms.
